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Ten years follow-up data of Tac QD (Advagraf) treated renal transplant patients
Abstracts
(55.5%) involved venous and 54 (45.5%) involved arterial control. Slippage and dislodgement of locking clips were reported to occur in at least 38 cases, while staple malfunction occurred at least 40 times. Blood transfusion and open conversion (from laparoscopic approach) were reported by 34 (28.1%) respondents. There was at least 1 death from hemorrhage related to VM clip dysfunction. A variety of LDN and VM techniques are extant within Europe where approximately 6500 LDN procedures are performed annually. Hemorrhagic complications of LDN with fatal and non-fatal outcomes still occur. Strikingly, many surgeons do not use the vascular control method that they consider most safe, and apparently persist in applying clips to the renal artery and other major vessels. Clip failures are known to cause donor death from sudden massive hemorrhage. Control of major vessels in LDN must employ transfixion techniques for optimal donor safety. doi:10.1016/j.trim.2014.11.130
B14-1099 Liver transplantation with pediatric donors after cardiac and brain death; a comparative study Rianne van Rijna, E.R. Pieter Hooglanda, Frank Lehnerb, L.W. Ernest van Heurna, Robert J. Portec a
Department of Surgery, Maastricht University Medical Center, Netherlands b Department of General, Visceral and Transplant Surgery, Medizinische Hochschule Hannover, Germany c Department of Surgery, Section HPB Surgery and Liver Transplantation, University Medical Center Groningen, Netherlands Background and aims: Liver transplantation with grafts from donors after cardiac death (DCD) is increasingly accepted as a valuable extension of the donor pool, but DCD liver grafts from pediatric donors are only rarely transplanted and their outcome is relatively unknown. The objective of this retrospective cohort study was to assess the effect of warm ischemic injury on pediatric grafts. The outcome of liver transplantation with grafts from pediatric DCD was compared to that with grafts from pediatric donors after brain death (DBD). Methods: The results of all liver transplantation from 2002 until 2011 with Dutch pediatric grafts aged 16 years or younger were reviewed. Data was obtained from the Dutch National Organ Transplantation Registry, with additional center data. Graft survival, patient survival, rate of primary non-function (PNF), and complications were compared between DCD and DBD grafts with log rank test, logistic regression analysis and Cox-regression analysis respectively. Results: In total, 82 liver transplantations with pediatric grafts were performed; twelve (15%) DCD and 70 (85%) DBD. Death censored graft survival was lower in DCD than in DBD recipients (58% versus 81% at 5 years, p = 0.040), which was caused by a higher rate of PNF in DCD grafts (odds ratio 22.33, p = 0.010). Death censored graft survival of grafts functioning after 3 months was not significantly different (78% in DCD versus 85% DBD recipients at 5 years, p = 0.647). Recipient survival and rate of complications were not significantly different. Conclusion: The results suggest that warm ischemic injury may lead to poor graft survival in pediatric grafts. However recipient survival is not affected and long term survival of functioning grafts is equivalent. The conditions for liver transplantation with pediatric DCD grafts have yet to be investigated in larger study populations in order to identify grafts with acceptable graft survival allowing maximal expansion of the donor pool.
doi:10.1016/j.trim.2014.11.131
227
B14-1100 Ten years follow-up data of Tac QD (Advagraf) treated renal transplant patients M. Christiaansa, H. Mullensa, M. Gelensa, E.v. Duijnhovena, E. van Heurnb, J. Vanderlochtc, J.P. van Hooffa a
Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands b Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands c Department of Transplant Immunology Lab, Maastricht University Medical Center, Maastricht, The Netherlands Introduction: Tacrolimus is used since the mid 90s as Tac BID (Prograf). In 2003, 40 stable renal transplant patients (RTx) participated in a phase 2 pharmacokinetic study on conversion (conv) from Tac BID to Tac QD (once daily, Advagraf). At the end, 39 RTx continued in the follow-up study (Tac QD on compassionate use). We describe their 10-year clinical data. Methods: Data were collected from patient files and given as number or median + range. Results: Two RTx returned to Tac BID b4 months after conv (increased liver enzymes and dizziness) and were excluded from analysis. The characteristics of the 37 included RTx were: Male 25 (68%); orig disease: immunologic 16 (IgA 7), PCKD 9, others 7, urologic 3, and cardiovascular: 2. Tx-number: first 30 (81%), re-Tx 7. Donor type: living 11, HB 17, and NHB 9. Donor age at Tx 45.0 (range 15–69) years. Median age RTx at conversion: 55.3 years (range 20–64). Time of conversion 4.1 years postTx (range 1.5–11.4). Immunosuppression at conv: Tacro monotherapy 29 (78%), Duotherapy 8 (MMF 5, Pred 3). Three RTx stopped later Tac QD and were censored due to switching to: – Sirolimus at year 2 (recurrent skin cancers; restart Tac due to Sirolimus intolerance); – Tac BID at year 3 (supposed allergy and restart Tac due to lack of improvement. Both have a good graft function 14 resp. 15-year postTx; – The 3rd RTx was withdrawn from study at year 4 (non-compliance) with restart Tac BID. Graft failed after 6 years (13-year postTx) due to chron humoral rejection. 34 RTx (89%) were continuously on Tac QD during follow-up. Patient survival (Kaplan–Meier) at 5 and 10-year postconv was 92% and 85% resp. Five patients died with a functioning graft 1.2–9.2year postconv (2× cardiovascular, 1× each pulmonary adenocarcinoma pulmonary embolism and Creutzfeldt–Jakob disease). Death-censored graft survival (Kaplan–Meier) at 5 and 10-year postconv was 100% and 83% resp. The 5 graft losses (8.2–9.0 years after conv) were due to: 3× recurrent IgA, 1 × ‘chronic rejection’, 1 × ATN postoperative. There were no acute rejections. Creatinine at conv was 128 umol/L (range 64–180) and creatinine at 10 years 141 umol/L (range 66–304). Conclusion: Although an observational study, it shows excellent Graft survival, patient survival, and renal function during 10-year follow-up on Tac QD with 78% of the RTx on monotherapy! Graft failures were mainly due to recurrent disease (high rate of recurrent IgA!) with only 1 (chronic) allograft rejection. doi:10.1016/j.trim.2014.11.132
(55.5%) involved venous and 54 (45.5%) involved arterial control. Slippage and dislodgement of locking clips were reported to occur in at least 38 cases, while staple malfunction occurred at least 40 times. Blood transfusion and open conversion (from laparoscopic approach) were reported by 34 (28.1%) respondents. There was at least 1 death from hemorrhage related to VM clip dysfunction. A variety of LDN and VM techniques are extant within Europe where approximately 6500 LDN procedures are performed annually. Hemorrhagic complications of LDN with fatal and non-fatal outcomes still occur. Strikingly, many surgeons do not use the vascular control method that they consider most safe, and apparently persist in applying clips to the renal artery and other major vessels. Clip failures are known to cause donor death from sudden massive hemorrhage. Control of major vessels in LDN must employ transfixion techniques for optimal donor safety. doi:10.1016/j.trim.2014.11.130
B14-1099 Liver transplantation with pediatric donors after cardiac and brain death; a comparative study Rianne van Rijna, E.R. Pieter Hooglanda, Frank Lehnerb, L.W. Ernest van Heurna, Robert J. Portec a
Department of Surgery, Maastricht University Medical Center, Netherlands b Department of General, Visceral and Transplant Surgery, Medizinische Hochschule Hannover, Germany c Department of Surgery, Section HPB Surgery and Liver Transplantation, University Medical Center Groningen, Netherlands Background and aims: Liver transplantation with grafts from donors after cardiac death (DCD) is increasingly accepted as a valuable extension of the donor pool, but DCD liver grafts from pediatric donors are only rarely transplanted and their outcome is relatively unknown. The objective of this retrospective cohort study was to assess the effect of warm ischemic injury on pediatric grafts. The outcome of liver transplantation with grafts from pediatric DCD was compared to that with grafts from pediatric donors after brain death (DBD). Methods: The results of all liver transplantation from 2002 until 2011 with Dutch pediatric grafts aged 16 years or younger were reviewed. Data was obtained from the Dutch National Organ Transplantation Registry, with additional center data. Graft survival, patient survival, rate of primary non-function (PNF), and complications were compared between DCD and DBD grafts with log rank test, logistic regression analysis and Cox-regression analysis respectively. Results: In total, 82 liver transplantations with pediatric grafts were performed; twelve (15%) DCD and 70 (85%) DBD. Death censored graft survival was lower in DCD than in DBD recipients (58% versus 81% at 5 years, p = 0.040), which was caused by a higher rate of PNF in DCD grafts (odds ratio 22.33, p = 0.010). Death censored graft survival of grafts functioning after 3 months was not significantly different (78% in DCD versus 85% DBD recipients at 5 years, p = 0.647). Recipient survival and rate of complications were not significantly different. Conclusion: The results suggest that warm ischemic injury may lead to poor graft survival in pediatric grafts. However recipient survival is not affected and long term survival of functioning grafts is equivalent. The conditions for liver transplantation with pediatric DCD grafts have yet to be investigated in larger study populations in order to identify grafts with acceptable graft survival allowing maximal expansion of the donor pool.
doi:10.1016/j.trim.2014.11.131
227
B14-1100 Ten years follow-up data of Tac QD (Advagraf) treated renal transplant patients M. Christiaansa, H. Mullensa, M. Gelensa, E.v. Duijnhovena, E. van Heurnb, J. Vanderlochtc, J.P. van Hooffa a
Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands b Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands c Department of Transplant Immunology Lab, Maastricht University Medical Center, Maastricht, The Netherlands Introduction: Tacrolimus is used since the mid 90s as Tac BID (Prograf). In 2003, 40 stable renal transplant patients (RTx) participated in a phase 2 pharmacokinetic study on conversion (conv) from Tac BID to Tac QD (once daily, Advagraf). At the end, 39 RTx continued in the follow-up study (Tac QD on compassionate use). We describe their 10-year clinical data. Methods: Data were collected from patient files and given as number or median + range. Results: Two RTx returned to Tac BID b4 months after conv (increased liver enzymes and dizziness) and were excluded from analysis. The characteristics of the 37 included RTx were: Male 25 (68%); orig disease: immunologic 16 (IgA 7), PCKD 9, others 7, urologic 3, and cardiovascular: 2. Tx-number: first 30 (81%), re-Tx 7. Donor type: living 11, HB 17, and NHB 9. Donor age at Tx 45.0 (range 15–69) years. Median age RTx at conversion: 55.3 years (range 20–64). Time of conversion 4.1 years postTx (range 1.5–11.4). Immunosuppression at conv: Tacro monotherapy 29 (78%), Duotherapy 8 (MMF 5, Pred 3). Three RTx stopped later Tac QD and were censored due to switching to: – Sirolimus at year 2 (recurrent skin cancers; restart Tac due to Sirolimus intolerance); – Tac BID at year 3 (supposed allergy and restart Tac due to lack of improvement. Both have a good graft function 14 resp. 15-year postTx; – The 3rd RTx was withdrawn from study at year 4 (non-compliance) with restart Tac BID. Graft failed after 6 years (13-year postTx) due to chron humoral rejection. 34 RTx (89%) were continuously on Tac QD during follow-up. Patient survival (Kaplan–Meier) at 5 and 10-year postconv was 92% and 85% resp. Five patients died with a functioning graft 1.2–9.2year postconv (2× cardiovascular, 1× each pulmonary adenocarcinoma pulmonary embolism and Creutzfeldt–Jakob disease). Death-censored graft survival (Kaplan–Meier) at 5 and 10-year postconv was 100% and 83% resp. The 5 graft losses (8.2–9.0 years after conv) were due to: 3× recurrent IgA, 1 × ‘chronic rejection’, 1 × ATN postoperative. There were no acute rejections. Creatinine at conv was 128 umol/L (range 64–180) and creatinine at 10 years 141 umol/L (range 66–304). Conclusion: Although an observational study, it shows excellent Graft survival, patient survival, and renal function during 10-year follow-up on Tac QD with 78% of the RTx on monotherapy! Graft failures were mainly due to recurrent disease (high rate of recurrent IgA!) with only 1 (chronic) allograft rejection. doi:10.1016/j.trim.2014.11.132